When Babies Don't Come
Tuesday, March 24, 1998; Page Z19
Robin Herman's review of
Overcoming Infertility: A Compassionate Resource for Getting Pregnant
By Robert Jansen, MD
W.H. Freeman, New York
474 pp., $16.95
By the time partners start looking for books on infertility, they probably
suspect -- or even know for sure -- that it will not be easy for them to have
children. They have already experienced shock and sadness, anger and
confusion. It may be painful just to approach the appropriate section of the
library or bookstore.
And when they peruse the shelves for information, they are not merely
browsing. The book they select, just like the doctor they ultimately choose
to help them, must feel "right." It has to address their particular situation,
recognize their emotional needs and, above all, treat them with respect.
In "Overcoming Infertility: A Compassionate Resource for Getting
Pregnant," Robert Jansen, director of an infertility clinic in Sydney,
Australia, presents a surefooted, thoughtful and, indeed, compassionate
book on the myriad aspects of infertility and its treatment. Using a
supportive but not overly personal tone, he has created a handbook that in
its self-contained chapters and detailed boxes allows the reader to take
exactly what he or she needs. And in giving his medical opinions, Jansen
has avoided the posture of many infertility specialists who write as though
they are your personal doctor -- or worse, your friend -- and can "solve"
your infertility if only you follow their detailed advice on high-tech
treatments.
Jansen's book is a marvel of organization. Reproductive endocrinology is a
fast-moving, competitive and lucrative field, where the options for
treatment can confuse even the most attentive of patients. It is not enough
to bring lists of questions to a gynecologist or gather clinic brochures. After
the consultation, when the numbing effect of bad test results fades, question
after question arises about what has happened and what will happen. Here
is where Jansen helps. He manages to be comprehensive without burying
the reader in detail. And he moves progressively through choices, from
diagnosis to treatment, allowing the reader to bypass other people's
problems.
Jansen explains that all the infertility problems you've ever heard of come
down to either 1) too few normal sperm reaching the fallopian tubes, 2)
too few normal eggs leaving the ovaries, 3) a blocked fallopian tube
stopping egg from meeting sperm or 4) an inability of the embryo to
implant in the uterus. Jansen's clarity itself provides relief.
From this starting point, Jansen sets out to describe the diagnostic tests for
each problem and then the options for treatment: the now well-established
techniques of in vitro fertilization (IVF) and gamete intrafallopian transfer
(GIFT) and their variations, but also the possibilities of sperm and egg
donation and surrogacy -- with all the moral ambiguities. He offers advice
on cases where the cause of infertility remains unknown, and he does not
overlook men's problems.
Jansen's experience comes as a professor in reproductive medicine and
surgery at the University of Sydney and the medical director of Sydney
IVF, an infertility clinic. He understands the emotionally charged act of
picking up his book, and he begins by addressing his readers' anger and
stress. The opening chapter, "Pregnancy and Chance," offers a perspective
on "normal" pregnancy rates and suggests a riposte for the infuriating
comments of well-meaning friends.
"The evidence in this chapter should mean goodbye to the do-gooders
who tell people to relax and then they'll get pregnant," he writes. "There is
just no evidence that this is true for most people. Certainly it is good for the
chance of getting pregnant to have sex more often, but you can forget the
myth that there is some mysterious, psychological link between the stress
of not getting pregnant and continuing not to. Thinking about infertility does
not stop someone from getting pregnant."
A fat glossary allows readers to keep up with their physicians' vocabulary
and understand the workings of the drugs they've been prescribed.
Welcome and surprising are chapters on the moral and ethical choices that
infertility patients will face. Also welcome is the chapter on the physician's
duties -- giving readers encouragement to voice their needs and
expectations.
Jansen doesn't abandon the reader at the positive pregnancy test. A late
chapter deals frankly with how previous infertility treatment may affect an
eventual pregnancy in ways medical and emotional.
"Your pregnancy, if you have had assisted conception, is not the same as
that of everyone else," Jansen writes. "Do not let anyone tell you anything
different." He speaks of the higher anxiety throughout the pregnancy, the
possibility of multiple birth because of IVF or other techniques, and the
small but real risk that the cervix may not hold as it should if the woman
has had a large number of gynecological procedures during infertility
treatment.
Acknowledging the infertile couple's position, he adds: "Even if there is no
increased risk of things going wrong, the pregnancy may be practically
irreplaceable, and the hazard of pregnancy loss is by its nature a greater
one than for someone who has no trouble getting pregnant."
My only criticism is that the detailed boxes Jansen provides are often so
technical as to be indigestible. But then again, they are isolated in boxes
that can be sampled or skipped. I do not begrudge Jansen his final chapter
arguing in favor of embryo research. As he points out, when people
actually endure the dehumanizing experience of infertility themselves or
witness a loved one's ordeal, they sometimes change their philosophical
opposition to such research.
While infertility is common enough nowadays -- because we start our
families at a much older age than did previous generations and because of
the effects of sexually transmitted diseases -- it is still a devastating
experience for every individual. It is hard to even accept that the term
"infertile" applies to oneself, and it takes courage to open a book that maps
out the road ahead. Jansen proves an excellent, trustworthy guide.
Robin Herman is a freelance writer in Paris.
© Copyright 1998 The Washington Post Company